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Aim: The aim of this study is to elucidate the patterns of characteristic hypometabolism on 18F-Fluoro Deoxy-glucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in the variants of Progressive supranuclear palsy (PSP) and its correlation with their core clinical features. Material and Methods: A retrospective analysis of 88 subjects with clinically suspected PSP was done. An institutional informed consent to participate in the study was taken from all the subjects. All the subjects had undergone a prior 99mTechnetium labeled Tropane derivative of dopamine transporter Single Photon Emission Computed Tomography (99mTc TRODAT-1 SPECT) study and had abnormal scans to confirm degenerative parkinsonism. The subjects were clinically examined by the neurologists using the Progressive Supranuclear Palsy Rating Scale proposed by the Movement Disorder Society and were further clinically segregated into eight subtypes. All the included subjects further underwent a detailed clinical analysis to obtain their individual Schwab and England activities of daily living scale and Modified Hoehn and Yahr staging by a neurologist. All the subjects underwent 18F-FDG PET/CT scan after adequate preparation. The scans were analyzed both qualitatively (visually) and quantitatively using Statistical Parametric Mapping. Results: The frontal, limbic, and sensorimotor cortices represented the common areas of hypometabolism among all the subtypes of PSP. The subcortical regions showing the most significant hypometabolism were the thalami, mid-brain, nucleus accumbens, caudate, globus pallidus, and putamen in descending order. Multiple cortical and subcortical regions of hypometabolism were identified in different subtypes of PSP. Conclusion: The characteristic patterns of hypometabolism observed in the different subgroups were more apparent on quantification and based on visual analysis alone, it may not be possible to differentiate the different subtypes of PSP. A good correlation was seen between some of the core clinical features and hypometabolic clusters.

Aim: The aim of this study is to elucidate the patterns of characteristic hypometabolism on 18F-Fluoro Deoxy-glucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in the variants of Progressive supranuclear palsy (PSP) and its correlation with their core clinical features. Material and Methods: A retrospective analysis of 88 subjects with clinically suspected PSP was done. An institutional informed consent to participate in the study was taken from all the subjects. All the subjects had undergone a prior 99mTechnetium labeled Tropane derivative of dopamine transporter Single Photon Emission Computed Tomography (99mTc TRODAT-1 SPECT) study and had abnormal scans to confirm degenerative parkinsonism. The subjects were clinically examined by the neurologists using the Progressive Supranuclear Palsy Rating Scale proposed by the Movement Disorder Society and were further clinically segregated into eight subtypes. All the included subjects further underwent a detailed clinical analysis to obtain their individual Schwab and England activities of daily living scale and Modified Hoehn and Yahr staging by a neurologist. All the subjects underwent 18F-FDG PET/CT scan after adequate preparation. The scans were analyzed both qualitatively (visually) and quantitatively using Statistical Parametric Mapping. Results: The frontal, limbic, and sensorimotor cortices represented the common areas of hypometabolism among all the subtypes of PSP. The subcortical regions showing the most significant hypometabolism were the thalami, mid-brain, nucleus accumbens, caudate, globus pallidus, and putamen in descending order. Multiple cortical and subcortical regions of hypometabolism were identified in different subtypes of PSP. Conclusion: The characteristic patterns of hypometabolism observed in the different subgroups were more apparent on quantification and based on visual analysis alone, it may not be possible to differentiate the different subtypes of PSP. A good correlation was seen between some of the core clinical features and hypometabolic clusters. [ABSTRACT FROM AUTHOR]

Chieh-Hsin Lin,1–3 Hsien-Yuan Lane2,4 1Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, 2Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, 3Center for General Education, Cheng Shiu University, Kaohsiung, Taiwan, 4Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan Abstract: Major depressive disorder (MDD) and Parkinson’s disease (PD) share symptoms such as tremor. Bupropion, a norepinephrine–dopamine reuptake inhibitor, shows weak dopamine transporter (DAT) occupancy. We report here on a patient with MDD whose hand tremors might have been misdiagnosed as PD by single-photon emission computed tomography (SPECT) under bupropion use. A 66-year-old male patient with MDD had been receiving bupropion 150 mg per day for 6 months. His mood symptoms improved partially with bupropion treatment, however, hand tremors persisted. The neurological examination revealed bilateral hand tremors without other typical signs for PD. The SPECT using Tc-99m TRODAT-1 revealed decreased DAT binding capacity in bilateral striata. Under the impression of atypical PD, the patient was advised to take anti-Parkinson’s drug. Bupropion was discontinued for 14 days to confirm the test. The follow-up SPECT after 14 days found improvement for the uptake ratio of striata. From then onward, the anti-Parkinson’s drug was not used due to the lack of typical sign(s) for PD. The patient’s mental and physical status remained stable without worsening of hand tremors during follow-up. Tc-99m TRODAT-1 SPECT is helpful for the evaluation of DAT and the diagnosis of PD. However, the interpretation of the SPECT image might be biased by the use of certain drugs such as bupropion for its binding to DAT. Bupropion may decrease the Tc-99m TRODAT-1 binding to DAT. The effect of drugs on DAT should be carefully assessed while interpreting the Tc-99m TRODAT-1 image. Our findings suggest that all drugs that may alter DAT occupancy should be listed as the reference for Tc-99m TRODAT-1 image reading. Keywords: bupropion, dopamine transporter, single-photon emission computed tomography, Parkinson’s disease, Tc-99m TRODAT-1

Major depressive disorder (MDD) and Parkinson's disease (PD) share symptoms such as tremor. Bupropion, a norepinephrine-dopamine reuptake inhibitor, shows weak dopamine transporter (DAT) occupancy. We report here on a patient with MDD whose hand tremors might have been misdiagnosed as PD by single-photon emission computed tomography (SPECT) under bupropion use. A 66-year-old male patient with MDD had been receiving bupropion 150 mg per day for 6 months. His mood symptoms improved partially with bupropion treatment, however, hand tremors persisted. The neurological examination revealed bilateral hand tremors without other typical signs for PD. The SPECT using Tc-99m TRODAT-1 revealed decreased DAT binding capacity in bilateral striata. Under the impression of atypical PD, the patient was advised to take anti-Parkinson's drug. Bupropion was discontinued for 14 days to confirm the test. The follow-up SPECT after 14 days found improvement for the uptake ratio of striata. From then onward, the anti-Parkinson's drug was not used due to the lack of typical sign(s) for PD. The patient's mental and physical status remained stable without worsening of hand tremors during follow-up. Tc-99m TRODAT-1 SPECT is helpful for the evaluation of DAT and the diagnosis of PD. However, the interpretation of the SPECT image might be biased by the use of certain drugs such as bupropion for its binding to DAT. Bupropion may decrease the Tc-99m TRODAT-1 binding to DAT. The effect of drugs on DAT should be carefully assessed while interpreting the Tc-99m TRODAT-1 image. Our findings suggest that all drugs that may alter DAT occupancy should be listed as the reference for Tc-99m TRODAT-1 image reading. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to elucidate the patterns of characteristic hypometabolism on 18 F-Fluoro Deoxy-glucose ( 18 F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in the variants of Progressive supranuclear palsy (PSP) and its correlation with their core clinical features., Material and Methods: A retrospective analysis of 88 subjects with clinically suspected PSP was done. An institutional informed consent to participate in the study was taken from all the subjects. All the subjects had undergone a prior 99mTechnetium labeled Tropane derivative of dopamine transporter Single Photon Emission Computed Tomography (99mTc TRODAT-1 SPECT) study and had abnormal scans to confirm degenerative parkinsonism. The subjects were clinically examined by the neurologists using the Progressive Supranuclear Palsy Rating Scale proposed by the Movement Disorder Society and were further clinically segregated into eight subtypes. All the included subjects further underwent a detailed clinical analysis to obtain their individual Schwab and England activities of daily living scale and Modified Hoehn and Yahr staging by a neurologist. All the subjects underwent 18 F-FDG PET/CT scan after adequate preparation. The scans were analyzed both qualitatively (visually) and quantitatively using Statistical Parametric Mapping., Results: The frontal, limbic, and sensorimotor cortices represented the common areas of hypometabolism among all the subtypes of PSP. The subcortical regions showing the most significant hypometabolism were the thalami, mid-brain, nucleus accumbens, caudate, globus pallidus, and putamen in descending order. Multiple cortical and subcortical regions of hypometabolism were identified in different subtypes of PSP., Conclusion: The characteristic patterns of hypometabolism observed in the different subgroups were more apparent on quantification and based on visual analysis alone, it may not be possible to differentiate the different subtypes of PSP. A good correlation was seen between some of the core clinical features and hypometabolic clusters., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Annals of Indian Academy of Neurology.)